腹部超聲精選課件

1、腹部超聲精選腹部超聲精選2Also known as-Abdominal ultrasound (US) scanning-Abdominal US imaging-Abdominal ultrasonography -Abdominal ultrasound 4Also known as3About the course5About the course4What is Abdominal Sonography? What is an Abdominal Sonogram?What are some common uses of the procedure? How would patien

2、ts prepare? How does the procedure work? What does the equipment look like? Who interprets the results? What are the benefits vs. risks? What are the limitations of Abdominal USG? Ultrasonography Info6Ultrasonography Info5What is Abdominal Sonography? Abdominal sonography is a method of obtaining im

3、ages of internal organs by sending high-frequency sound waves into the body. The reflected sound waves are returned as echoes. The echoes are then recorded and displayed as a real-time visual image. Since ultrasound images are captured in real-time they have the ability to show movement of internal

4、tissues, liver function, and blood flow. 7What is Abdominal Sonography?6Ultrasonography is a noninvasive medical test that helps physicians diagnose and treat medical conditions.An abdominal ultrasonography produces a picture of the organs and other structures in the upper abdomen.What is Abdominal

5、Sonography? 8Ultrasonography is a noninvas7A Doppler ultrasound study may be part of an abdominal ultrasound examination. Doppler ultrasound is a special ultrasound technique that evaluates blood as it flows through a blood vessel, including the bodys major arteries and veins in the abdomen, arms, l

6、egs and neck.What is Abdominal Sonography? 9A Doppler ultrasound study ma8What is an Abdominal Sonogram? An abdominal sonogram can help to diagnose a variety of conditions and to assess damage caused by illness.Liver, gallbladder, spleen, pancreas, and kidneys will be evaluated during an abdominal s

7、onogram. Various reasons are: abdominal pain, abnormal lab results, and enlarged abdominal organs.10What is an Abdominal Sonogra9What is an Abdominal Sonogram? An abdominal sonographer will be required to image small body parts as well. These parts include: thyroid gland, testicles, breast, and vari

8、ous soft tissue of body parts. Doctors can also use abdominal sonography to guide them as they perform needle biopsies on abdominal organs. 11What is an Abdominal Sonogra10What are some common uses of the procedure? -Kidneys -Liver -Gallbladder -Pancreas -Spleen -Abdominal aorta and other blood vess

9、elsAbdominal ultrasound imaging is performed to evaluate the:12What are some common uses of11What are some common uses of the procedure? Abdominal pains Abnormal liver function Enlarged abdominal organ Abnormalities in the abdomen :gallstones, liver cirrhosis, cyst, tumor, etc. An aneurysm in the ao

10、rta 13What are some common uses of12What are some common uses of the procedure? Doppler ultrasound images can help the physician to see and evaluate:Blockages to blood flow (blood clots/atherosclerotic plaque) Narrowing of vessels (which may be caused by plaque) Tumors and congenital malformation 血凝

11、塊/動(dòng)脈粥樣硬化斑塊14What are some common uses of13What are some common uses of the procedure? Guide invasive procedures such as needle biopsy and withdrawal of fluid 15What are some common uses of14How would patients prepare? （）wear comfortable, loose-fitting clothing（）barium enema or upper GI (gastrointest

12、inal) tests鋇餐灌腸 上消化道檢查16How would patients prepare? 15For a study of the liver, gallbladder, spleen, and pancreas, patient may be asked to eat a fat-free meal on the evening before the test and then to avoid eating for 8 to 12 hours before the test. For ultrasound of the kidneys, may be asked to dri

13、nk 4 to 6 glasses of water about an hour before the test to fill your bladder. may be asked to avoid eating for eight to 12 hours before the test to avoid gas buildup in the intestines. For ultrasound of the aorta, you may need to avoid eating for eight to 12 hours before the test.How would patients

14、 prepare? 17How would patients prepare? 16In case of an emergency, exams can be done without special preparations. Tell the sonographer, sonologist, or physician conducting the examination about pain, bleeding, or any other symptoms. Telling the examiner about past ultrasounds and surgeries is helpf

15、ul, and sometimes provides crucial information. （重要信息）How would patients prepare? 18In case of an emergency, exa17How does the procedure work? You will be positioned on an examination table and made to lie down on your back and lay your hands above your head. It may become necessary to change positi

16、ons during the exam, and lie down on your side or sit up. A lubricating gel（甘油凝膠/耦合劑） is applied to the patients abdominal area. 19How does the procedure work?18How does the procedure work? An apparatus known as a transducer is placed on the abdominal area and moved around to get real time images.So

17、metimes you will have to breathe in and hold your breath according to the technologist, sonologist, or physicians instructions. Examinations usually take 10-30 minutes. 20How does the procedure work?19Small structure-higher-frequency linear arrayAbdomen-curved/linear/arrayEchocardiography-sectorObst

18、etric & gynecologic-curved arrayInstrumentation21Small structure-higher-fre20Who interprets the results?A radiologist, or sonogist22Who interprets the results?A21What are the benefits vs. risks? Benefitsnoninvasive (no needles or injections) and is usually painless. widely available, easy-to-use and

19、 less expensive than other imaging methods. uses no ionizing radiation. gives a clear picture of soft tissues that do not show up well on x-ray images. causes no health problems and may be repeated as often as is necessary. provides real-time imaging, making it a good tool for guiding minimally inva

20、sive procedures such as injections, needle biopsies and needle aspiration of fluid23What are the benefits vs. ri22What are the benefits vs. risks? RisksFor standard diagnostic ultrasound there are no known harmful effects on humans. Pregnant women and fetuses can be safely examined. 24What are the b

21、enefits vs. ri23What are the limitations of Abdominal USG? Ultrasound waves are disrupted by air or gas; therefore ultrasound is not an ideal imaging technique for the bowel or organs obscured by the bowel. In most cases, barium exams, CT scanning, and MRI are the methods of choice in this setting.2

22、5What are the limitations of 24What are the limitations of Abdominal USG? Ultrasound waves do not pass through air; therefore an evaluation of the stomach, small intestine and large intestine may be limited. Intestinal gas may also prevent visualization of deeper structures such as the pancreas and

23、aorta. Large patients are more difficult to image because tissue attenuates (weakens) the sound waves as they pass deeper into the body26What are the limitations of 25Gallstones and cholecystitis 膽結(jié)石，膽管炎Hepatitis/liver cirrhosis 肝炎/肝硬化Kidney/Bladder stones 腎/膽囊結(jié)石Hydronephrosis 腎積水Tumors 腫瘤Cancers of

24、 the liver, kidneys, pancreas, gallbladder, biliary tree 癌Lymphoma 淋巴瘤Metastasis 轉(zhuǎn)移灶Cysts 囊腫Infections 感染Common conditions revealed by Abdominal sonography27Gallstones and cholecystitis26Abscesses 膿腫Appendicitis 闌尾炎Enlarged liver, spleen, kidneys, lymph nodes 增大Pancreatitis 胰腺炎Congenital malformatio

25、n 先天畸形Injury - hematoma, tear, rupture 創(chuàng)傷（血腫、撕裂、破裂）Hemorrhage of the adrenal gland 腎上腺出血Abdominal aortic aneurysm 腹主動(dòng)脈瘤Ascites腹水Peritonitis腹膜炎Bowel obstruction 腸梗阻Hernia 疝氣28Abscesses 膿腫FOUNDATIONSFOUNDATIONS28Sonographic TerminologyDescriptive terminologyHyperechoic-Hypoechoic(高回聲低回聲)Isoechoic（等回聲）

26、Anechoic or sonolucent（無(wú)回聲）Enhancement（回聲增強(qiáng)）Heterogeneous-Homogeneous（非均質(zhì)/均質(zhì)） Shadowing（聲影）30Sonographic TerminologyDescr29HyperechoicshadowingHypoechoicHyperechoicHypoechoicshadowing31HyperechoicshadowingHypoecho30HeterogeneousHomogenousAnechoicSonolucentEnhancementIsoechoic32HeterogeneousHomogenou

27、sAnech31Sonographic EvaluationThe sizeThe echo and attenuation of the organParenchyma實(shí)質(zhì)The texture質(zhì)地The presence of vascular structures, ligaments, and fissures裂隙Abnormality異常 and mass占位33Sonographic EvaluationThe si32The normal or abnormal images of abdominal organs34The normal or abnormal image33T

28、he LiverUltrasound is often the first line of investigation for suspected liver pathology and the decision to proceed to secondary investigative procedures, such as further radiology or histology. Ultrasound is used in the diagnosis, staging and monitoring of liver disorders and also contributes to

29、their treatment with ultrasound-guided invasive procedures.Developing technology and techniques now result in improved diagnostic accuracy and are increasingly obviating the need for further radiology.Intraoperative and laparoscopic ultrasound, using high-frequency, direct-contact techniques, set th

30、e standard for liver imaging in many cases.35The LiverUltrasound is often343635The simple cyst has three acoustic properties anechoichas a well-defined smooth capsuleexhibits posterior enhancement (increased through transmission of sound)肝囊腫hepatic cyst37The simple cyst has three ac36肝血管瘤 Hepatic he

31、mangiomaSmall solitary or multiple nodular lesionRounded well-definedHyperechoic massUsually not visualize colour flow38肝血管瘤 Hepatic hemangiomaSmall37術(shù)語(yǔ)TermsThis term describes the effect of a focal mass, whether benign or malignant, on surrounding structures and is a useful diagnostic tool. It impl

32、ies the lesions displacing or invasive nature, i.e. the displacement of vessels and/or invasion or distortion of adjacent structures and tissues as a result of the increasing bulk of a lesion. This effect differentiates a true mass from an infiltrative process占位效應(yīng)Mass effect39術(shù)語(yǔ)TermsThis term descri

33、bes t384039Benign hepatic tumors hemangioma, hepatocellular adenoma, hepatic cystadenoma, FNH(focal nodular hyperplasia) etc.Malignant tumors hepatocarcinoma, hepatocholangiocarcinoma, metastases, lymphoma etc Hepatic tumors41Benign hepatic tumorsHepatic40Types massive type nodular type diffusely in

34、filtrating type Vascular invasionPathologyPrimary CarcinomaHepatic tumors42TypesPathologyPrimary Carcin41Echoic patternSonographic types InvasionColor Doppler Flow ImageUSG FeatureHepatic tumors43Echoic patternUSG FeatureHep42hyperechoichypoechoichypoechoicisoechoic44hyperechoichypoechoichypoech4345

35、444645VI Differential DiagnosesCystHemangiomaMetastasesPrimary Carcinoma47VI Differential DiagnosesCy46Clinical FindingsUSG FindingsHemangiomaN/ASolitary or multipleRound or ovalWell-defined borderHyperechoic（most parts）Color flow Primary Ca80%HCC70%HCC AFPAbnormal LFTsSolitary or multipleInfiltrati

36、ve,diffuseHypoechoic, isoechoic, hyperechoicPortal veins/hepatic veins invadedthrombusMetastases轉(zhuǎn)移性肝癌Abnormal LFTsSolitary or multipleWell-,ill-definedHypoechoic or hyperechoicDiffuse distortion of bulls eye pattern48Clinical FindingsUSG Finding47hemangiomaSimple hepatic cyst49hemangiomaSimple hepat

37、ic cys485049hyperechoichypoechoichypoechoicisoechoicHepatic carcinoma51hyperechoichypoechoichypoech50Metastatic tumor52Metastatic tumor51USG-Guided Liver Biopsy Liver biopsy is a diagnostic procedure used to obtain a small amount of liver tissue, which can be examined under a microscope to help identify the cause or stage of liver disease.53USG-Guided Liver Biopsy Liv52The gallbladderUltrasound is an essential first-line investigation in suspected gallbladder and biliary duct disease It is highly sensitive, accurate and comparatively cheap Gallbladder pathol